【摘要】 目的探讨学习曲线内后腹腔镜输尿管上段切开取石术的手术难点。方法 2007年7月～2010年12月由作者完成后腹腔输尿管上段切开取石术33例(男25例,女8例)。患者分为前期组(A组)16例和后期组(B组)17例。比较两组输尿管寻找、双J管的植入和输尿管缝合时间及手术并发症。结果两组患者结石平均大小相近([22.0±5.5):(20.0±5.0)mm,P>0.05],手术出血量相当。A组输尿管寻找时间([24.0±6.4):(10.0±3.7)min,P<0.05]、置入双J管时间(18.0±7.2):(8.0±3.7)min,P<0.05]、输尿管缝合时间([30.0±7.5):(13.0±3.6)min,P<0.05]和总手术时间([116.0±20.4):(72.0±12.2)min,P<0.05]显著多于B组。两组均无1例改行开放手术,A组1例双J管放置不到位发生漏尿,1例术后6个月发生输尿管狭窄。B组无1例并发症发生。结论输尿管结石的定位寻找和输尿管缝合、双J管的置入是学习后腹腔镜输尿管上段切开取石术的技术难点。后腹腔镜输尿管上段切开取石术学习曲线大约需15例左右经验积累,即可达到较熟练程度。更多还原

【Abstract】 [Objective] To investigate the difficulties of retroperitoneal laparoscopic ureterolithotomy(RLU) for upper ureteral calculi in learning curve.[Methods] Between July 2007 and December 2010,33 cases(25 males and 8 females) consecutive retroperitoneal laparoscopic ureterolithotomies were reviewed by author during the learning curve period in laparoscopy.Patients were divided and into group A(the first 16 patients) and group B(late 17 patients).Timing for ureter isolation,ureteral double J stent placement and ureter suturing were recorded.Intraoperative complications and perioperative morbidity were also reported.[Results] There was no statistical difference in stone size between groups [(22.0±5.5) vs.(20.0±5.0) mm,P >0.05].Significant differences between group A and B were observed in terms of time for access to the operating field [(24.0±6.4) and(10.0±3.7) min,respectively,P <0.05],time for double J ureteric stent placement [(18.0±7.2) and(8.0±3.7)min,respectively,P <0.05],time for suturing the ureter [(30.0±7.5) and(13.0±3.6) min,respectively,P <0.05];and total operative time [mean times(116.0±20.4) and(72.0±12.2) min,respectively,P <0.05].No statistical differences were observed for any other parameters.Blood loss was minimal in all cases(mean losses 67 and 50 mL,respectively,P >0.05);One patient developed urinary leakage because of displacement double J ureteric stent.At the 6-month follow-up,1 cases of ureteral stricture were recorded in group A.[Conclusions] The operative difficulties were ureter isolation,ureteral double J stent placement and ureter suturing during the learning curve period in RLU.The learning curve of the RLU requires approximately 15 cases to achieve more proficiency.更多还原